金哲 梅兰

摘要 目的：觀察升降散合小陷胸汤加减辨治痰热瘀阻证糖调节受损的疗效，初步分析其起效原因。方法：选取2017年6月至2019年6月辽宁中医药大学附属第二医院收治的老年糖调节受损患者84例作为研究对象，按照随机数字表法分为对照组和观察组，每组42例。2组患者均给予生活方式干预等常规措施，对照组患者在此基础上加用盐酸二甲双胍片口服，观察组在常规措施基础上加用升降散合小陷胸汤加减治疗。比较治疗前后患者体质量指数（BMI）、糖脂代谢指标、中医证候积分、胰岛素抵抗情况变化，检测血清中脂肪细胞型脂肪酸结合蛋白（A-FABP）、脂联素（ADPN）、白细胞介素-18（IL-18）、肿瘤坏死因子-α（TNF-α）水平。结果：1）治疗后，观察组患者的BMI、糖脂代谢指标改善较对照组明显，BMI、HbAlc、2 h PBG、FPBG、TC、TG水平均显著低于对照组（P<0.05）;2）治疗后，观察组患者的中医证候积分与对照组比较显著降低（P<0.05）;3）治疗后，观察组患者的2 hINS、FINS、HOMA-IR与对照组比较显著降低，HOMA-β则与对照组比较显著升高（P<0.05）;4）治疗后，观察组患者的血清中A-FABP、IL-18、TNF-α水平显著低于对照组，ADPN水平显著高于对照组（P<0.05）;5）观察组的有效率94.87%（37/39），较对照组的有效率80.00%（32/40）明显升高，差异有统计学意义（χ2=3.950，P<0.05）。结论：升降散合小陷胸汤加减利于改善糖调节受损患者临床症状，调节糖脂代谢，减轻胰岛素抵抗，保护胰岛B细胞功能，初步分析原因可能与下调血清中A-FABP、IL-18、TNF-α表达、升高ADPN水平有关，值得临床推广。

关键词 糖调节受损;痰热瘀阻证;升降散;小陷胸汤;脂肪细胞型脂肪酸结合蛋白;脂联素;炎症介质;临床研究

Therapeutic Effect of Shengjiang Powder and Xiaoxianxiong Decoction in the Treatment of Patients with Impaired Regulation of Phlegm Heat Stasis Syndrome

JIN Zhe，MEI Lan

（Diabetes Department，the Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine，Shenyang 110003，China）

Abstract Objective：To observe the effect of Shengjiang Powder and Xiaoxianxiong Decoction in the treatment patients with impaired glucose regulation of phlegm heat stasis syndrome and to preliminarily analyze the cause of its effect.Methods：A total of 84 elderly patients with impaired glucose regulation admitted to he Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were divided into an observation group and a control group according to the random number table method，with 42 patients in each group.Patients in both groups were given routine measures such as lifestyle intervention.Patients in the control group were given metformin hydrochloride orally on the basis of this，and patients in the observation group were given Shengjiang Powder and Xiaoxianxiong Decoction on the basis of conventional measures.The changes of BMI，glucose and lipid metabolism index，TCM syndrome score and insulin resistance were compared before and after treatment.The serum levels of A-FABP，ADPN，IL-18 and TNF-αwere detected.Results：1） After treatment，the BMI，glucose and lipid metabolism indexes of the observation group improved significantly compared with the control group，and the levels of BMI，HbAlc，2 h PBG，FPBG，TC and TG were significantly lower than those of the control group （P<0.05）.2） After treatment，the TCM syndrome score of the observation group was significantly lower than that of the control group （P<0.05）.3） After treatment，2 hINS，FINS，HOMA-IR in the observation group were significantly lower than those in the control group，while HOMA-β were significantly higher than those in the control group （P<0.05）.4） After treatment，the serum levels of A-FABP，IL-18 and TNF-α in the observation group were significantly lower than those in the control group，and the levels of ADPN were significantly higher than those in the control group （P<0.05）.5） The effective rate of the observation group was 94.87% （37/39），which was significantly higher than that of the control group 80.00% （32/40），and the difference was statistically significant （χ2=3.950，P<0.05）.Conclusion：Shengjiang Powder combined with Xiaoxianxiong Decoction beneficial to improve the clinical symptoms of patients with impaired glucose regulation，regulate glucose and lipid metabolism，reduce insulin resistance，and protect the function of pancreatic islet cells.The preliminary analysis may be related to down-regulating the expression of A-FAB，IL-18，TNF-αin serum，and increasing the level of ADPN，which is worthy of clinical promotion.

Keywords Impaired glucose regulation; Phlegm heat stasis syndrome; Shengjiang Powder; Xiaoxianxiong Decoction; Fatty acid-binding protein; Adiponectin; Inflammatory factors; Clinical research

中圖分类号：R255.4;R259文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.04.019

糖调节受损（Impaired Glucose Regulation，IGR）表现为一种糖调节失衡，经血浆葡萄糖测定值显示多介于正常血糖与糖尿病之间，是2型糖尿病（T2DM）的主要危险因素[1]，可见空腹血糖受损（Impaired Fasting Glucose，IFG）和糖耐量受损（Impaired Glucose Tolerance，IGT）2种状态独现或并存。因大多患者无明显临床症状，故易于被忽视。目前，该病的发病机制尚未明确，普遍认为与胰岛素抵抗、B细胞功能受损、炎症反应密切相关[2]。现代医学临床为延缓或阻断患者向糖尿病进展的趋势，主要以生活方式干预为主，适当给予改善胰岛素抵抗、保护胰岛B细胞的分泌功能等干预措施，但尚无理想的干预药物[3]，因此，探求有效的干预IGR方式对于降低IGR进展为2型糖尿病的风险、提升转归的概率具有重要意义。……